434415331-4-12-2023-52-CC-AELT-CQU2MR-20230412173135

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415331
Report Date: 04/12/2023
Date Signed: 04/12/2023 05:31:44 PM

Document Has Been Signed on 04/12/2023 05:31 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	STOCK FARM ROAD CHILDREN'S CENTER		FACILITY NUMBER:	434415331
ADMINISTRATOR:	OLLIA YENIKOMSHIAN		FACILITY TYPE:	850
ADDRESS:	183 STOCK FARM ROAD		TELEPHONE:	(650) 736-8465
CITY:	STANFORD	STATE: CA	ZIP CODE:	94305
CAPACITY: 76	TOTAL ENROLLED CHILDREN: 76	CENSUS: 58	DATE:	04/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:45 AM
MET WITH:	Senchal Rodriguez		TIME COMPLETED:	05:45 PM

NARRATIVE

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On 04/12/2023 at 2:45, Licensing Program Analysts Andrew Elliot and Michael Mathew arrived at the facility to conduct UNANNOUNCED RANDOM REQUIRED 1 YEAR SITE INSPECTION. LPAs met with facility director Senchal Rodriguez and advised her the purpose of the inspection. LPAs were provided a tour of the facility inside and out. There were 58 children in care and 11 staff at the time of the inspection.

EMERGENCY PREPAREDNESS/SAFETY: LPA observed smoke and carbon monoxide detectors were tested and found to be functioning. First aid supplies are available. A fire/disaster drill was last conducted on 04/12/2023 and meets the six-month requirement. Facility has working telephone service.Per facility director, there are no armed guards or fire arms present at the facility. The Emergency Disaster Plan confirmed to be current.

LICENSING POSTING: All REQUIRED forms are posted and visible for public review: Facility license, Notification of Parents’ Rights, Earthquake Preparedness, Emergency Disaster Plan. Licensee was reminded that exersaucers, baby walkers, bouncers, jumpers, and similar items are not allowed, and that smoking is prohibited in the smoking is prohibited in the facility at all times.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Andrew Elliott
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: STOCK FARM ROAD CHILDREN'S CENTER	FACILITY NUMBER: 434415331
	VISIT DATE: 04/12/2023

NARRATIVE

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Safe Sleep

LPA discussed the safe sleep regulations with facility director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

CHILD RECORDS REVIEW: Facility director was able to provide a complete list of children’s records for all children present during the visit. Each file contained LIC 613A Personal Rights Statement, Admission Agreement, Needs and Services Plan for Infants, LIC 9224 Acknowledgment of Receipt of Licensing Reports, LIC 700 Identification and Emergency Information, LIC 701 Physician’s Report, LIC 955 Notification of Parent’s Rights, LIC 627 Consent for Emergency Medical Treatment, and Immunization Records.

STAFF RECORDS REVIEW: Facility director was able to provide a complete list of staff documents for all adults present and/or working at the facility. LPA observed that each staff’s file contains Staff Qualifications, LIC 508 Health Screening Report LIC 9052 Employee Rights documentation, Current TB Clearances, and LIC 9108 Statement of Acknowledgment of Requirement to Report Child Abuse.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Andrew Elliott
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: STOCK FARM ROAD CHILDREN'S CENTER	FACILITY NUMBER: 434415331
	VISIT DATE: 04/12/2023

NARRATIVE

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LPA Observed that Mandated Reporter Training Certificates were present in some staff files, but were missing or expired for staff 6, staff 7, staff 8, and staff 10. A Type B citation will be issued for these missing documents.

LPA Observed that Proof of Immunization for Measles, pertussis and influenzas was not present for employee # 10. A second Type B citation will be issued for these missing document

TYPE B/ TECHICAL VIOLATIONS:

1 Type B violation will be cited today for staff members failing to maintain mandated reporter training certification 4 staff members failed to complete the training or had expired training that was not renewed within 2 years.

1 Type B violation will be cited today for staff member # 10 not having Proof of Immunization for Measles, pertussis and influenzas

2 Type B Violations cited today. This report shall remain on file for 3 years.

A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed by facility director.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Andrew Elliott
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/12/2023 05:31 PM - It Cannot Be Edited

Created By: Andrew Elliott On 04/12/2023 at 05:06 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: STOCK FARM ROAD CHILDREN'S CENTER	FACILITY NUMBER: 434415331
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care. LPA observed staff member did not have immunization in file. Director stated that staff 10 provided immunization records to previous director, and that those records were misplaced.
	POC Due Date: 04/14/2023
	Plan of Correction
1 2 3 4	Director agreed to send copy of immunization records to LPA by close of busniess on 04/15/2023.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care. LPA observed 3 staff members with invalid mandated reporter training certificate. Facility director was aware of invaild mandated reporter trainings.
	POC Due Date: 04/17/2023
	Plan of Correction
1 2 3 4	Director agreed to send completed mandated reporter training certificates to LPA by close of business on 04/17/2023 via email or text message

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Wynn Norona

LICENSING EVALUATOR NAME:

Andrew Elliott

LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

LIC809 (FAS) - (06/04)

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